October 7, 2024: Talking about Risk

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care

If you were to ask someone how they felt right now, most would say … “I feel fine”. Some are fine. They are young and healthy and have little need for medical services.

Others respond “I am fine” but they have a number of significant risk factors. They may be diabetic, in CHF, experiencing all forms of distress and they are actually not fine. They do not use primary care preferring subspecialist care. They are not yet having an event that leads them to urgicare, the ER or in for a hospital stay. Others have dropped over the edge some time ago. They are both high risk and high cost.

Using data to assess risk and responding effectively is the key.

Being able to succeed with your value based proactive paid contracts will require that you and your system get very good at using data to risk stratify and developing processes within your practice that allow you to do the following:

First, identify those people who are at high risk

Second, create processes within your practice that ensure that staff can identify the risk within the individual patients they deal with each day and be sure that the high risk/low cost receive preferential attention when they contact your office. You want them in ASAP. C

Third, your team needs a plan to reach out proactively to these patients, to get them in for a comprehensive visit. These people are the ones who most benefit from Advanced Primary Carel. Your team can work miracles.

Fourth, you and your team need to understand and effectively respond to the health literacy level of the patients. People’s motivation vary as does their ability to grasp ideas, interpret reports shared with them, etc.

Fifth, your team needs to build loyalty among your patients so that they think of you first when they have a health/medical concern. Proactively sharing information that is relevant to them as patients is created “stickiness”. Create an e-newsletter or listserv so you can share materials with them. They like hearing from their doctor. It is easy and inexpensive with a platform like “Constant Contact”.

We appreciate that if you are working in a hospital owned practice, the administrators will want to control this. But most administrators focus on marketing and not service. Work with them. Convince them over time.